叩鸣如咳肺如钟，俞氏合邪得正宗，表里热寒皆？附，盛衰久暂隐相从。六经生克崇中
土（虚劳诸咳嗽，必以脾胃药收功，）五法神明主小（青）龙（汤，《金匮》变为五方。）更有不传言外
旨，胸中支饮勿姑容（此句从《医门法律》得其秘。
咳嗽初由风寒，久久不愈，则声哑羸瘦，痰中带血，气喘偏睡，变成虚痨。时医或谓外
邪失表所致，或谓内伤及酒色过度所致。既已成痨，即戒用辛热之品，取甘润之剂，静而养
阴，令真阴复而阳不亢，金水相滋，则咳嗽诸病除矣。然此说一行，误人无算，南医六味地
黄丸、黑归脾汤等料，加麦门冬、五味子、淡菜胶、海参、阿胶胶、人乳粉、秋石霜、紫河
车、叭杏仁、川贝母、猪脊髓之类，百服百死，诚堪痛恨。余读《金匮》书中，隐寓有大手
眼。喻嘉言亦悟其妙，俱引而不发者，难与俗人言也。余临证以来，每见咳嗽百药不效者，
迸去杂书之条绪纷繁。而觅出一条生路，止于《伤寒论》得之治法。《伤寒论》云∶“上焦
得通，津液得下，胃气因和”三句，是金针之度。盖风寒之邪，挟津液而上，聚于膈中，以
致咳嗽不愈。若风寒不解，其津液何以得下耶。若误行发散，不惟津液不下，而且转增其上
逆之势矣。此所以通其上，即和其中，和其中，愈通其上也。至于风寒缠绵不已，积而成痨
，及一切痰火，哮喘，咳嗽瘰 等症，皆缘火势熏蒸日久，顽痰胶结经隧，所以火不内息，则津
液不能下灌灵根，而菁华尽化为败浊耳。且人全赖水谷之气生此津液，津液结则病，津液枯
则死矣。《伤寒论》小柴胡汤谓∶“咳者去人参，生姜加干姜，五味子。”此为伤寒言，而
不尽为伤寒言也。余取“上焦得通”三句，借治劳伤咳嗽，往往获效。
咳嗽之声如叩击空鸣，肺脏如同钟磬，喻嘉言（俞氏）认为合邪致病才得其正宗，表证与里证、热证与寒证皆可依附于此，病势的盛衰和病程的久暂都隐含其中。六经的生克关系推崇中土（虚劳诸种咳嗽，必须以调理脾胃的药物收功），五种治法的神妙之处在于主用（小）青龙汤（《金匮要略》由此演变为五个方剂）。更有不直接言明却蕴含外旨的治疗原则，胸中的支饮之邪不可姑息宽容（此句从《医门法律》中获得其奥秘。
咳嗽起初由风寒引起，若久久不愈，则声音嘶哑、身体消瘦，痰中带血，气喘且偏向一侧睡眠，最终变成虚劳。当时的医生有的认为是外邪未能及时发散所致，有的认为是内伤及酒色过度所致。既然已经形成痨病，就应禁止使用辛热性质的药物，改用甘润性质的药剂，静养以滋养阴液，使真阴恢复而阳气不亢盛，金（肺）水（肾）相互滋生，那么咳嗽等病症自然消除。然而这种说法一流行，误人无数，南方医生常用六味地黄丸、黑归脾汤等药料，加入麦门冬、五味子、淡菜胶、海参、阿胶胶、人乳粉、秋石霜、紫河车、巴杏仁、川贝母、猪脊髓之类，服百次死百次，实在令人痛恨。我阅读《金匮要略》一书，发现其中隐寓着大手笔的眼界。喻嘉言也领悟到其中的奥妙，但都引而不发，难以与世俗之人言说。我自临诊以来，每见咳嗽百药无效的病例，摒弃杂书中纷繁复杂的条绪，而觅出一条生路，止于《伤寒论》中的治法。《伤寒论》说：“上焦得通，津液得下，胃气因和”这三句话，是金针度人的法则。大概风寒之邪，挟带津液而上行，聚集在膈中，导致咳嗽经久不愈。如果风寒不解，津液怎么能下行呢？如果错误地施行发散疗法，不仅津液不能下行，反而会增加其上逆的趋势了。这就是所以通畅上焦，就能调和其中焦；调和其中焦，就能更通畅上焦的原因。至于风寒缠绵不已，积久形成痨病，以及一切痰火、哮喘、咳嗽瘰疬等症状，都是因为火势熏蒸日久，顽痰胶结在经络隧道中，所以火气在内不能平息，津液就不能向下灌溉灵根（肾/先天之本），而精华全部化为败浊之物。况且人全靠水谷之气产生津液，津液凝结则生病，津液枯竭则死亡。《伤寒论》中小柴胡汤的加减法说：“咳者去人参，生姜加干姜，五味子。”这是针对伤寒而言，但并不完全局限于伤寒。我取“上焦得通”这三句话，借用治疗劳伤咳嗽，往往获得疗效。
The sound of coughing is like striking a hollow object, and the lungs are like a bell. Yu Jia Yan (Yu Shi) holds that only by recognizing the combination of pathogens does one grasp the orthodox approach; both exterior and interior, heat and cold can be attached to this principle, while the excess or deficiency and duration of the disease follow implicitly. The generation and restriction among the Six Channels revere the Middle Earth (for various types of consumptive coughs, treatment must conclude with medicines regulating the Spleen and Stomach). The divine efficacy of the Five Methods lies primarily in the Xiao Qing Long Tang (Minor Blue Dragon Decoction), which, according to *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), evolves into five formulas. Furthermore, there are unspoken yet profound principles hidden within the text: branchy fluid retention (Zhi Yin) in the chest must not be tolerated (This sentence derives its secret from *Yi Men Fa Lv* / Medical Rules and Laws).
Cough initially arises from Wind-Cold. If it persists for a long time without healing, it leads to hoarseness, emaciation, blood-tinged sputum, wheezing, and a preference for sleeping on one side, eventually transforming into Consumption (Lao Bing). Contemporary physicians may attribute this to the failure to release exterior pathogens early on, or to internal injury caused by excessive alcohol and sexual indulgence. Once consumption has formed, pungent and hot substances should be strictly avoided; instead, sweet and moistening agents should be used to nourish Yin quietly. When True Yin recovers and Yang does not become hyperactive, Metal (Lung) and Water (Kidney) mutually nourish each other, thereby eliminating cough and related diseases. However, once this theory became prevalent, countless people were misled. Southern physicians often prescribed Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) and Hei Gui Pi Tang (Black Spleen-Restoring Decoction), adding herbs such as Mai Men Dong (Ophiopogonis Radix), Wu Wei Zi (Schisandrae Fructus), Dan Cai Jiao (Concha Meretrix Gelatin), Hai Shen (Holothuria), E Jiao (Colla Corii Asini), Ren Ru Fen (Human Milk Powder), Qiu Shi Shuang (Sal Petrosae), Zi He Che (Placenta Hominis), Ba Xing Ren (Prunus Armeniaca Seed), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), and Zhu Ji Sui (Porcine Spinal Cord). Patients who took these remedies hundred times died hundred times, which is truly lamentable. Upon reading *Jin Gui Yao Lue*, I discovered it contains profound diagnostic insights. Yu Jia Yan also perceived its subtleties but chose to hint rather than explicitly state them, as they are difficult to explain to ordinary people. Since beginning my clinical practice, I have frequently encountered cases of cough unresponsive to hundreds of medicines. By discarding the complex and confusing entries from miscellaneous books and seeking a path to survival, I found the solution lies solely in the therapeutic methods of *Shang Han Lun* (Treatise on Cold Damage). *Shang Han Lun* states: "When the Upper Jiao becomes unobstructed, fluids descend, and the Stomach Qi harmonizes." These three sentences constitute the golden needle method. Generally, Wind-Cold pathogens carry fluids upward, accumulating in the diaphragm, leading to persistent cough. If Wind-Cold remains unresolved, how can fluids descend? If dispersing methods are mistakenly applied, not only will fluids fail to descend, but their rebellious upward movement will increase. This explains why unblocking the upper part harmonizes the middle, and harmonizing the middle further unblocks the upper. As for prolonged Wind-Cold that accumulates into consumption, as well as all forms of Phlegm-Fire, asthma, cough, and scrofula, these arise because fire steams and smolders for a long time, causing stubborn phlegm to congeal in the meridians and collaterals. Consequently, if internal fire does not subside, fluids cannot irrigate the spiritual root (Kidney/Essence), and essence is entirely transformed into turbid waste. Moreover, humans rely entirely on Qi from food and drink to generate fluids; when fluids congeal, disease occurs; when fluids dry up, death ensues. In the Xiao Chai Hu Tang (Minor Bupleurum Decoction) formula from *Shang Han Lun*, it says: "For cough, remove Ren Shen (Ginseng Radix), Sheng Jiang (Zingiberis Rhizoma Recens), and add Gan Jiang (Zingiberis Rhizoma) and Wu Wei Zi (Schisandrae Fructus)." This statement addresses Cold Damage but is not limited to it. I apply the principle of "Upper Jiao becoming unobstructed" to treat consumptive cough and often achieve efficacy.